What:
On the 50th anniversary of equal prize money for Men and Women at the U.S. Open, we will discuss gender disparities in sports and sports medicine with doctors from Mount Sinai Hospital, the medical services provider for the annual New York City Tennis Grand Slam.
When: August 24, 2023, 11 AM to 12 PM EST (tentative)
Who: Panelists include:
Alexis Colvin, MD, Professor of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai, Chief Medical Officer of the U.S. Open
Melissa Leber, MD, Associate Professor of Orthopedics and Emergency Medicine at Icahn Mount Sinai, Director of Player Medical Services of the U.S. Open
Where: Newswise Live Events Zoom Room (link will be given once you register)
Details:
Doctors from Mount Sinai Hospital will discuss gender disparities and sports medicine ahead of The US Open Tennis Championships.
Media register here to attend and/or receive transcript
TRANSCRIPT
Thom Canalichio: Welcome tennis fans to this Newswise Live Event. The US Open starts next week, so today we are serving up a Q&A session with doctors managing the medical team from Mount Sinai Hospital. Media on the call are welcome to chat their questions and we'll volley them to the panelists for you and hopefully match you up with some good quotes from them. After the event, a transcript and a recording will be available. You can also reach out to Emma at Mount Sinai for any follow-up questions and I'm sure she'd love to help you out. Her email address is [email protected]. I'm going to enter that into the chat for everyone. I'd like to introduce Dr. Alexis Colvin. She's MD and Professor of Orthopedic Surgery at the Icahn School of Medicine at Mount Sinai and Chief Medical Officer of the US Open. And also we have Dr. Melissa Leber, MD, Associate Professor of Orthopedics and Emergency Medicine at Icahn Mount Sinai, Director of Player Medical Services for the US Open. Welcome both of you, thank you so much for joining. And let's start off with if you can tell us a little bit about some research that you have in progress and any info that you can share. I know it's still in progress, but media might be interested in hearing about it once it's coming out in the journal. Can you tell us a little bit about the fitness levels of tennis players as an overall category?
Dr. Alexis Colvin: There's a study that I did, which I can also send you the link to later, but, what it looked like, as we know that exercise, of course, has many benefits, but we don't necessarily know sports specific ones, and especially tennis in general. So this is actually probably one of the largest studies that were done was 10,000 recreational tennis players in the US. And what we did was we looked at a forum called the SF 36. And what it is, it's an objective form. What this form is, it’s a standardized form that looks at health as we define it by physical, mental, social, and it's been used in many, many other disease processes to look at how someone, for instance, with eye blood pressure compares to or other conditions compares to normative values, so the general population. And so we sent this survey to the 10,000 recreational tennis players in the United States. And what we found was that on every single variable tennis players score higher than the general population. So this is, like I said, it's probably one of the largest studies that's been done and was an objective way of showing that tennis specifically is good for your health.
Thom Canalichio: Fantastic, and I would recommend for any media that might be interested to reach out to Emma there at Mount Sinai and she can update them when this is going to be published.
Dr. Alexis Colvin: It has been published.
Thom Canalichio: And if you can share that info that would be fantastic, so that we can relay that to the to the media. Another topic is that this is the 50th anniversary for the US Open having equal pay for both the male and female athletes. Meanwhile, women are underrepresented in orthopedics research and lots of other areas. How far have we come in your opinion? What is there still to do in these areas of gender equity?
Dr. Alexis Colvin: Well, we still have a long way to go. So you're right, like you brought up a lot of the research in sports medicine, in particular, has focused on a small group of sports - football, basketball - the ones that you would typically think of, and primarily on males. In terms of thinking like “why is this?”, so one of the potential reasons is that practicing repeating surgeons and female practicing orthopedic surgeons are less than 7% of Orthopedic Surgeons overall. So I would think that certainly one factor that's there, there's a lot that we need to do there. There's certainly some research that has been done in terms of gender and its effect on ACL injuries. I think it's probably one of the best studied ones, but that's certainly an area that will be robust for research. The other thing is that, especially tennis, female athletes careers are going longer. As we know Serena had a baby and then came back and played. So I think there's a lot of research that can be done on pre and perinatal female athletes to help them not only plan for this period of their life, because a lot of times the prime playing time is actually also the prime, you know, motherhood time, and then also how to plan for coming back after having a baby.
Thom Canalichio: Very interesting. How, for example, might training regimens or recovery differ for male and female athletes? Are there some ways that female athletes get treated differently that are not necessary? or some that are? An example that we spoke about was strength training for young women athletes. Tell us a little bit about that. And what, obviously, more research needs to be done about that? As you said, Dr. Colvin, so much has not been done in this area. So Dr. Leber or Dr. Colvin, any thoughts about those questions?
Dr. Melissa Leber: Yeah, so I mean, the thing we had mentioned was that female athletes are not typically focusing from a young age on any kind of weight, strength and resistance training, whereas male athletes tend to lift weights, you know, their whole lives. And why is that? It's just something that is just ingrained in us and how we train. You know, women don't want to look, you know, big, but in order to be a good athlete, in order to prevent an injury, and prevent overuse injuries, we know that you need to be strong. And so strength and resistance training is very important. And starting young girls out on some form of strength and resistance training, it's even more important now, in order to avoid injury. And we see that now with a lot of even elementary and middle schools, doing a lot of balance work and jumping work, things like that, in order to avoid ACL injury, for example, because we know young girls are more susceptible to that, for many reasons. But in order to prevent these injuries and other injuries, being strong as important, so we do do try to counsel our patients to, you know, keep up a strength training regiment, not just focus on cardio. In terms of rehab and recovery, currently, all of our athletes are using ice tubs, maybe the men more than the women. I don't know if you have a feeling on that. But we know that that's very important in terms of recovery. We know there's a big place in certain supplements, like there's a lot of evidence to show creatine can help but I don't know that men and women are being treated differently for that currently.
Thom Canalichio: And is there likely that research into that is needed to see if there are gender differences as to what the recommendations might be for certain things?
Dr. Melissa Leber: Certainly, yeah. I mean, there probably should be slightly different recommendations. You know, muscle bulk is different in men and women. And so men may need more muscle recovery than women might, whereas women might have, you know, different types of tightness or different types of things that might be more beneficial. You know, currently, at the US Open, we offer massage and acupuncture and certain medical treatments to help, and we have a laser and the ATP and WTA are trying out different forms of rehab and recovery to see what works best for the players, but it's pretty much the same currently for that.
Dr. Alexis Colvin: One of the things I would to just bring up is when we're talking about supplements in nutrition it’s that, as we know, men and women have different susceptibility to osteoporosis and stress fractures and athletes have even more load on them. So that's something we certainly need for further research in terms of recommendations for preventing stress fractures and osteoporosis in this group.
Thom Canalichio: Is osteoporosis generally more prevalent in women?
Dr. Alexis Colvin: It is, yeah.
Dr. Melissa Leber: Not in this age group, but later.
Thom Canaichio: Very interesting point; so any athlete who might be susceptible to that should be monitoring for her bone density as she ages to be preventing stress fracture.
Dr. Alexis Colvin: Yeah, I would say they would. There are known recommendations for supplementation for calcium and weight bearing exercise and that sort of thing, but I think because that’s for the recreational athlete population. But for the elite athlete, I think as we're starting to get more information and research, it certainly is an area where the recommendations may change for professional athletes.
Dr. Melissa Leber: And, Thom, you mentioned that girls at this age or women at this age should be monitoring their bone density. We don't generally recommend getting DEXA bone scans and monitoring bone density at such a young age unless they're extremely high risk, meaning they've already had a stress fracture to begin with, a history of disordered eating like anorexia, bulimia, irregular periods, and other risk factors like that and family history. So we don't generally screen athletes for bone health, unless they have risk factors currently.
Thom Canalichio: Very good. With a recent study that we discussed previously about doctors being given a patient profile with a gender neutral description, and the results of how the doctors handled that was somewhat interesting. How do you relate that to some of these questions about the differences between male and female athletes in sports medicine?
Dr. Melissa Leber: Well, so we were curious if we presented the same case, a meniscus injury and an athlete to male and female physicians, and we named the patient Sam, specifically, to be gender neutral, we had three different instances. We sent the instance of Sam without a picture so that the physician didn't know if it was male or female, we sent the instance of the same Sam with a male picture and one with a female picture, and to see if there were any differences in the physician treatment. And, currently, we didn't find any statistical difference in the treatment of physicians, which we found very interesting, because we weren't sure if male and female physicians would choose to treat their patients differently in that realm. But we need to look at that further, to learn more, but that's just a study that's not published and currently in the works.
Thom Canalichio: Title Nine famously created equality for women's sports at the school level, but there hasn't necessarily been a correlative investment in and dedication to things like research or bringing women in the STEM disciplines and going into certain medical specialties. What are your thoughts about what needs to be done to continue to raise that level of representation in the same way that Title Nine did for women's sports?
Dr. Alexis Colvin: You’re saying representation in STEM fields or?
Thom Canalichio: Yeah, in, as you said, your speciality of orthopedic surgery and only 7% of women in that, or the underrepresentation in research about these kinds of things. So what are some examples of what you'd like to see happen there?
Dr. Alexis Colvin: Well, I will tell you, there are some efforts already so I think exposure and education at a younger age in training is definitely something where that can be helpful. So, for instance, there are two groups that will expose High School females, in particular, to orthopedics and what orthopedic surgery is. But even in high school, you know, sometimes, I would say most people don't really know what they're doing for the rest of their life. But at least like, at that point, you've already kind of thought I'm better at science and math, or I'm more, you know, I'm not good at it. So I think being able to work hand in hand with the organizations that expose, especially younger girls, to STEM fields, I think would be a good way to help change those numbers.
Thom Canalichio: Aside from ACL tears that you mentioned earlier, that are more common in young women athletes, are there other common injuries that occur more in females versus males?
Dr. Melissa Leber: Stress fractures, since we talked about that, would be much. See, everything's kind of similar.
Dr. Alexis Colvin: Yeah, those are probably the two key ones where there's been more research then than others.
Thom Canalichio: So with the tournament starting next week, there's 17 separate venues hosting matches simultaneously at some points during it. What are some of the plans and strategies that you've implemented to be delivering emergency care across that big of an event? This is such a huge thing. It's the largest sporting event in the world. Tell us about that.
Dr. Melissa Leber: So yeah, we were saying that, basically, unlike soccer and football that have one field and one place to respond, those fields are much simpler in many ways, because basically, you have medical personnel on each sideline, you can have one piece of equipment and it can be shared amongst the field like an AED, for example.
Thom Canalichio: Describe AED for those who might not be familiar.
Dr. Melissa Leber: An AED is an Automatic External Defibrillator for cardiac arrest. So on a football field, you may only need one or two maximum, whereas here you might need 20, right, because we have upwards of 20 locations and courts, where we have athletes and we want to have a quick response time to them. So the more AEDs we have spread out, the quicker we can get defibrillator to player or patient with a cardiac arrest, and the quicker we can get that to them, the better it is for their care and decreases morbidity and mortality. But here, it's very difficult because we're responding to so many different fields or courts, if you will. So it's not quite as simple. We're running all over the place and we need - and the other thing is fans are not in the stands quite as much as they are at a football or soccer match. They're literally lining the courts - so we are dealing with some different challenges in medical care of these athletes to make a quick response, and swift, you know, transport to the hospital if needed. But that's kind of what we have to plan for.
Thom Canalichio: What are some common injuries that you expect to see at a tournament like this or what other issues might you be assisting the athletes with? For example, some players famously deal with cramping. Are there any tricks or recommendations for the kinds of things that you would offer for support of an athlete in that situation?
Dr. Melissa Leber: Yeah, so cramping falls under the overall term of heat illness for us. So heat illness can be feeling of like a summer flu where you know, you feel lightheaded, headache, achy, almost like you have a fever, but you don't. So you could feel, you know, fatigue, and then there's cramping as one level, it's on a spectrum of disease for heat illness. And all the way to the extreme of heatstroke being the one where an athlete might have altered mental status, and that's when their temperature really does go really high and dangerously high. So cramping is a super common one, and athletes are always educated on how best to prevent cramping, which can include proper electrolytes, and sodium repletion. The problem we find is that different athletes sweat at different rates, and their sweat is composed of different amounts of sodium. And so it's not always quite as simple as to say “okay, you need six bottles of this one drink, and then you're going to be fine” or “you need to prepare in this certain way and you're going to be fine”. There's actually ways to test an athlete's sweat rate. And they do that commonly in marathon runners, but also in tennis as well, so that they can know what the best and optimal nutrition is, and drink composition is, for them in order to prevent things like cramping, for example, and, of course, with heat illness. But all the athletes kind of are wearing these already, you know, moisture wicking fabrics, and, you know, light colored fabrics, things like that, along with the proper heat, nutrition, and hydration, all can help prevent things like cramping. But other common injuries, we see ankle sprains and calf and shoulder sprains.
Dr. Alexis Colvin: I think one of the things to keep in mind with tennis is that it really, it's a very unique sport in that there's no substitutions. You know, a player can play for 30 minutes, or they can play for three hours. They're playing on several different surfaces throughout the year, and they're really playing in tournaments from January through maybe the beginning of November. So when we see them, end of August, beginning September, they've really played a full year of tennis. And so when they come to the US Open, they know that they're going to get probably some of the best quality medical care in the world in New York City. And so they do see us for the things that we treat on the court, that you see on TV, so strains and sprains and that sort of thing, but they're also coming to us because Mount Sinai has all these other services that we can provide that they may not necessarily get throughout the rest of the year.
Thom Canalichio: And is it often that you see athletes who maybe had some injury months ago at another event or during training and they're still in the post-recovery or recovery of that and you're giving them advice about where they are and status and whatnot?
Dr. Melissa Leber: Yeah, absolutely. In fact, a lot of times we'll have athletes want to even repeat imaging that they may have gotten in other countries and they feel they trust our imaging more at Mount Sinai, you know, higher quality care, but also better images, and a lot of times we'll be repeating images, just so that they can get more definitive care with different opinions. And sometimes the opinions are the same, but sometimes they differ. But the point is that like Dr. Colvin said, you know, it's a year-round sport for them. A lot of times we can even be dealing with primary care issues from gynecologic issues, to chronic sprains and strains. So it's like they come to us for everything.
Thom Canalichio: What also is there to anticipate and prepare for with the fans? It's a huge event. There's 1000s, many 1000s, of fans attending and if there's any kind of medical emergency that's certainly something that you have to be taking care of. Tell us about how the plans are in preparing for that.
Dr. Alexis Colvin: So there is a group called Crowd RX, which deals solely with medical issues for the fans and the spectators. But similar to the athletes, you know, they're coming to watch in really hot and humid conditions. And so, similar messaging to the fans as well, and this is even before they come to the open in terms of, you know, heat and hydrating and wearing the light colored clothing and the hats. And there's certainly a lot of messaging.
Thom Canalichio: Sunblock.
Dr. Alexis Colvin: So that's very important, sunscreen, too.
Thom Canalichio: I'm a big sunscreen advocate. I get on anybody that I'm around outside doing something “did you wear sunscreen?” It's really important.
Dr. Alexis Colvin: Yeah, I 100% agree, and that's equally important, not just for the fans, but also the athletes and you know, even, there's a lot of staff that's on the grounds here, so the ball crew, and the officials and so on.
Thom Canalichio: What are your thoughts on what type of sunscreen, mineral-based barrier or chemical? What are your opinions,? Thumbs up thumbs down on mineral-based versus chemical.
Dr. Alexis Colvin: I think that the going thought right now is mineral is better, but I'm not a dermatologist.
Thom Canalichio: My my vote’s for mineral.
Dr. Alexis Colvin: The point I was going to make was that medical is really not just for the athletes. Of course, they're our number one priority, but it really extends to all the staff working here as well as the fans.
Thom Canalichio: Fantastic to know that there's so many resources to be on location for all that. More generally, for fans of the game - and a lot of fans of the game also are tennis players, recreational players, themselves. It's one of those sports that pretty much anyone can do at, you know, healthy and safe levels for much of their lives. And so a lot of people resort to it as a way to stay active and fit. What are any tips or precautions for those kinds of recreational players, and in particular, a similar related sport of pickleball rising in popularity meteoricly in recent years? I'm sure you are seeing patients with injuries from recreational play in both of those sports. Any tips, suggestions, precautions for the general rec level athlete?
Dr. Melissa Leber: I think there are many tips, starting with injury prevention, and overall, to be a better tennis player, you can't just play tennis. I think that goes with any sport, you really need to be a little bit of a well rounded athlete doing, as I said before, strength training, cardiovascular training, but also taking care of your body from a good diet perspective, good sleep perspective, in order to prevent injury and become a better tennis player. The other big thing on that is that, you know, these athletes have access to the best physios and rehab protocols, and the fans and other athletes, just recreational athletes, may not have that kind of access. But if you are able to treat yourself occasionally to a massage or even to physical therapy, all those reasons resources should be used and optimized to make yourself better and to prevent and avoid injury. You know, sometimes if you have an area of pain, it doesn't mean you should stop exercising altogether to fully rest everything. It just means you may need to alter your workout and your regiment to do something different while letting that specific area recover. For example, say you are a fan or recreational athlete and you have an ankle injury. Well clearly it's going to be tough for you to play tennis, but you can ride the bike, you can swim. There may be other things you can do, check with your doctor first of course, but you can also do strength training while seated or laying down. And so things can rest while other things are still working to keep you in the best shape possible. Other tips for fans? You know, tennis is kind of nice, because it's not a lot of equipment. So, any advice on equipment? Not really?
Dr. Alexis Colvin: No, I actually think that equipment is actually pretty important. There are a couple of simple things. One is the grip tape that's on the racket. It is important actually to change it because, you know, you can help prevent blisters that way and then also the grip -
Thom Canalichio: Shock absorption?
Dr. Alexis Colvin: Yeah, not so much though the tape keeps the racket from slipping in your hand and then, you know, potentially preventing blisters. And then also the grip can sometimes actually affect elbow pain. So when you have tennis elbow, one of the things we tried to do to remedy it is figure out, you know, with your grip, is it actually the right size that you're holding?
Thom Canalichio: So a wider or sore and more narrow grip could potentially help to alleviate that?
Dr. Alexis Colvin: Yeah. The second thing is the stringing that's done for the rackets. There's really a whole science behind it in terms of the type of string that you use, the type of pattern, the type of tension. And so if you are getting pain anywhere in your arm, for playing tennis, that is one thing to look into is actually speak to a stringer and see if there's a way that they can change around the equipment that you're using, because it can be tailored to you and what you're feeling.
Thom Canalichio: Very interesting, very interesting. Any recommendations about footwear?
Dr. Melissa Leber: You know, and that's it. Patients ask all the time, I don't know if you get this question. A patient says all the time “what sneakers should I buy?” Oh, you know what I mean? There's not one sneaker or sneaker brand, that's the best for everyone. And same with insole, there's not one that's meant for everyone, custom versus over the counter. It's really different based on you, and you have to go with what's the most comfortable for you. So just because something looks great, or all your friends are using something clearly doesn't mean it's the best. You have to really try out different shoes in different styles and see what's most comfortable for you.
Dr. Alexis Colvin: Can I actually go back to your racket questions? I have the privilege actually, when I travel with the village of King Cup team, there's a record stringer that comes with us. So I've actually learned a ton from her. So this is a whole separate topic, but for sure the population that I see the most injuries in is young athletes, is adolescent and kid athletes. And probably one of the most important things is that, you know, one of the first things we learned in medical school is that kids are not little adults, and that is 100% advice to use for the equipment you get your child for playing tennis. So there's differences in terms of the racquet head size, as well as the weight. So that's really important. I mean, every kid is different, of course, but it really is important that you're getting the right size equipment for your child, because that will definitely help in terms of preventing injury because we want them to have a long term career in tennis.
Thom Canalichio: Great point. Good advice. Thank you. Question from the chat here. Many coaches of female youth sports, particularly volunteers, they're not necessarily aware of the susceptibility to ACL injuries. So do you have any recommendations on how much practice time should be focused on or devoted to this area and particular kinds of exercises or warm ups that could help to prevent those kinds of injuries or at least begin increasing the education and awareness for those kinds of coaches?
Dr. Alexis Colvin: Yeah, that's a great question, and obviously, there's certain sports where females are more likely to get more susceptible to ACL tears just because of the cutting and pivoting of that sport, so soccer and basketball. There are established ACL, we call them pre-rehabilitation programs or ACL prevention programs that are relatively standardized, and so it's not like you just do it for a couple of weeks, and then you don't do it anymore. It needs to be part of the regular routine. So I think if that's something that you want to talk about, we can certainly send you some links to the standardized protocols.
Thom Canalichio: Very good. Thank you so much. I think that's all we have for today. If anybody on the call or media would like to ask further questions, you can contact Emma at Mount Sinai. I'm putting her email into the chat again, if you missed it earlier. Thank you so much doctors Coleman and Leber. Good luck with pulling off this event next week and hope that it's a huge success. I'm sure it will be. Thank you very much.
Dr. Alexis Colvin: Thank you.
Dr. Melissa Leber: Thank you.
Thom Canalichio: Have a great day. Bye.
Other Link: Improved General Health Outcomes in US Recreational Tennis Players
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